In this Aug. 18, 2017 photo, relatives of murdered doctor and mother, Jessica Sevilla Pedraza, carry a framed portrait of her, a cross, and a box of mementos to be buried alongside her grave, as they arrive for Mass in Villa Cuauhtemoc, Mexico state. Pedraza had been shot in the head and decapitated, and the skin had been flayed from her skull. (AP Photo/Rebecca Blackwell)

In this Aug. 15, 2007 photo, pink crosses covered with the Spanish words: "Truth," "Justice," and "Restitution" stand in a road median in downtown Nezahualcoyotl, Mexico state. In June, Valeria Teresa Gutierrez Ortiz, 11, disappeared in this town after taking a public bus home from school. She was later found dead in the abandoned vehicle, partially clothed and with signs of sexual assault. (AP Photo/Rebecca Blackwell)

In this Aug. 23, 2017 photo, Juana Pedraza, center, holds her one-year-old grandson Jose Leonardo, who they call Leon, as the family eats breakfast in their home in Villa Cuauhtemoc, Mexico state. The gruesome death of Pedraza's 29-year-old daughter Jessica, Leo's mother, was part of a wave of killings of women plaguing the sprawling State of Mexico. From left are Jessica's former partner and Leo's father, Alejandro Garcia, Jessica's sister Zurisadai, father Abel, and sister Diana Laura with her two children. (AP Photo/Rebecca Blackwell)

In this Aug. 25, 2017 photo, female nursing students stand in their socks as they take a self-defense workshop led by Muay Thai practitioners in Nezahualcoyotl, Mexico state. In Nezahualcoyotl, a group called Nos Queremos Vivas, or We Want to Stay Alive, sprung up after the murder of 11-year-old Valeria Gutierrez. It has organized marches and a self-defense workshop at a high school where 70 percent of the students are girls. (AP Photo/Rebecca Blackwell)

In this Aug. 18, 2017 photo, family members of slain Dr. Jessica Sevilla Pedraza attend a church service, holding a cross for her grave which they brought to be sprinkled with holy water, in Villa Cuauhtemoc, Mexico state. The daughter of a truck driver and a shop owner, Jessica went to college and became a doctor, cementing her place as the pride of the family. Her mother Juana and sister Ingrid comfort each other as ex-partner Alejandro Colin Garcia holds the cross. (AP Photo/Rebecca Blackwell)

In this Aug. 25, 2017 photo, Muay Thai practitioners demonstrate self-defense moves to mostly female students at a nursing school in Nezahualcoyotl, Mexico state. The mounting crisis of femicides _ murders of women where the motive is directly related to gender _ prompted the federal government to issue a gender violence alert in 2015, the first for any Mexican state. (AP Photo/Rebecca Blackwell)

In this Aug. 18, 2017 photo, Juana Pedraza sits beside an altar to her 29-year-old daughter, Jessica, inside the family's home in Villa Cuauhtemoc, Mexico state. Jessica's disappearance, on a Friday in August, set off a frantic 48 hours of searching by the family. Under the gender violence alert issued two years earlier, authorities are supposed to investigate any woman's disappearance urgently. But Pedraza said authorities told her to wait until Sunday afternoon. (AP Photo/Rebecca Blackwell)

In this Aug. 25, 2017 photo, female students at a nursing school look on during a self-defense workshop led by Muay Thai practitioners in Nezahualcoyotl, Mexico state. At one class, students threw punches and kicks on an indoor soccer court _ and talked about learning to be afraid from a young age, as the killings of women plagues Mexico's most populous state. (AP Photo/Rebecca Blackwell)

In this Aug. 23, 2017 photo, Juana Pedraza makes the bed in the room her daughter Jessica shared with her 1-year-old son in the family's home in Villa Cuauhtemoc, Mexico state. Pedraza identified her 29-year-old daughter's body at the morgue. She had been shot in the head and decapitated, and the skin had been flayed from her skull. "I can't understand why," Pedraza said. "Why so much fury? Why so much hate?" (AP Photo/Rebecca Blackwell)

In this Aug. 25, 2017 photo, a cleaning lady looks out the door of a nursing school, monitored by a security guard, in Nezahualcoyotl, Mexico state. The mounting crisis of femicides _ murders of women where the motive is directly related to gender _ prompted the federal government to issue a gender violence alert in the State of Mexico in 2015. (AP Photo/Rebecca Blackwell)

In this Aug. 23, 2017 photo, 1-year-old Jose Leonardo, known as Leon, looks up at his father Alejandro Garcia as his dad tries to get him dressed for the day in the room Leo shared with his mother Jessica Sevilla, in her family's home in Villa Cuauhtemoc, Mexico state. After Jessica's murder, her ex, Alejandro, is staying in the room together with their son. (AP Photo/Rebecca Blackwell)

In this Aug. 18, 2017 photo, Zurisadai Sevilla, holds flowers during a graveside ceremony to place a cross, flowers, and a box of mementos for her slain sister Jessica Sevilla, 29, in Villa Cuauhtemoc, Mexico state. Jessica's mutilated body was found on a highway about 20 miles (30 kilometers) from where she was last seen alive at a gas station in her red, brand-new Mazda. (AP Photo/Rebecca Blackwell)

In this Aug. 18, 2017 photo, a man kisses a cross brought by family members and friends of murdered Dr. Jessica Sevilla Pedraza, 29, at the entrance to the cemetery in Villa Cuauhtemoc, Mexico state. Jessica's gruesome murder remains unsolved. (AP Photo/Rebecca Blackwell)

In this Aug. 25, 2017 photo, a female nursing student climbs the stairs behind fellow male students at a nursing school in Nezahualcoyotl, Mexico state. The State of Mexico officially ranks second to the nation's capital with 346 killings classified as femicides since 2011, according to government statistics. (AP Photo/Rebecca Blackwell)

In this Aug. 18, 2017 photo, family and friends walk in procession from the church to the cemetery carrying a cross anointed with holy water to mark the grave of murdered doctor and mother Jessica Sevilla Pedraza, 29, in Villa Cuauhtemoc, Mexico state. Many violent crimes such as disappearances often go unreported and unpunished, and the State of Mexico is widely considered ground zero for killings of women in the country today. (AP Photo/Rebecca Blackwell)

In this Aug. 23, 2017 photo, Juana Pedraza sits next to a small altar in honor of her oldest daughter Jessica, who was murdered at age 29, as she sews school uniforms to order at her home in Villa Cuauhtemoc, Mexico state. Pedraza raised her five daughters to be confident that they are equal to men and that nobody can hold them back. Now tasked with raising her grandson, Jessica's son Leon, she said she's focusing on the other side of the equation: Schools teach kids to read and write, but other values are instilled at home. (AP Photo/Rebecca Blackwell)

In this Aug. 18, 2017 photo, a woman walks past the wall of a clothing store painted with the figure of a woman as advertising, next to phrase "No dumping garbage," in Villa Cuauhtemoc, Mexico state. "This problem is difficult to eradicate because it is rooted in ideas that assume that we as women are worth less than men, that we as women can be treated like trash," said Dilcya Garcia Espinoza de los Monteros, deputy state prosecutor for gender violence crimes, regarding femicides. (AP Photo/Rebecca Blackwell)

In this Aug. 25, 2017 photo, Muay Thai practitioners lead mostly female students at a nursing school in a self-defense workshop, in Nezahualcoyotl, Mexico state. "We want to help them prepare in case they have to defend themselves," martial arts instructor Cristofer Fuentes said. (AP Photo/Rebecca Blackwell)

In this Aug. 15, 2007 photo, a woman sits in front of a window inside a nursing school in Nezahualcoyotl, Mexico state. The nonprofit Citizen Observatory Against Gender Violence, Disappearance and Femicides in Mexico State counted 263 femicides in 2016 alone. Before Mexico State, it was Ciudad Juarez, across the border from El Paso, Texas, that was notorious for killings of women, with nearly 400 slain there since 1993 and only a handful of cases resulting in convictions. (AP Photo/Rebecca Blackwell)

By GUSTAVO MARTINEZ

Associated Press

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VILLA CUAUHTEMOC, Mexico — Just like any other day, Dr. Jessica Sevilla Pedraza went to work at the hospital that morning, came home for a quick lunch and then left again. The plan was to see more patients, hit the gym and be back in time for her usual dinner with dad before he went to his night-shift job.

Instead a hospital co-worker showed up at the family’s door in the evening. She said a man had come in with a bullet wound in his leg and told doctors he had been with Sevilla when gunmen intercepted them, shot him and took off with the doctor in her own car.

Sevilla’s gruesome death was part of a wave of killings of women plaguing the sprawling State of Mexico, which is the country’s most populous with 16 million residents and surrounds the capital on three sides. The crisis of femicides — murders of women where the motive is directly related to gender — prompted the federal government to issue a gender violence alert in 2015, the first for any Mexican state, and has recently prompted outcry and protests.

Sometimes the deaths are caused by domestic abuse. Other killings appear to be opportunistic, by strangers. Often the bodies are mutilated and dumped in a public place — which many read as a message to other women: There is no safe place, time of day or activity.

The week before Sevilla’s killing, 18-year-old Mariana Joselin Baltierra vanished when she walked to the corner store in Ecatepec, a hardscrabble suburb of Mexico City. Her body was found in a butcher shop next door; she had been sexually assaulted and disemboweled. The suspect, an employee at the butcher shop, allegedly took the money in the register and fled. He remains at large.

In June, Valeria Teresa Gutierrez Ortiz, 11, disappeared in Nezahualcoyotl after taking a public bus home from school. She was later found dead in the abandoned vehicle, partially clothed and with signs of sexual assault. The bus driver was arrested for the killing. Three days later he was found dead in his cell with a cord around his neck.

The State of Mexico officially ranks second to the nation’s capital with 346 killings classified as femicides since 2011, according to government statistics. Dilcya Garcia Espinoza de los Monteros, deputy state prosecutor for gender violence crimes, said femicides fell by about a third between January and July this year compared with the same period in 2016, but that can hardly be read as an indicator of improvement.

“We should not fall into this incomplete dance of figures where if we see an increase we believe we have to work extra hard and if there is a decrease we have no more work to do,” Espinoza said. “This problem is difficult to eradicate because it is rooted in ideas that assume that we as women are worth less than men, that we as women can be treated like trash.”

The government’s classification of “femicide” allows significant room for interpretation, and many say the official figures are understated and unreliable. Violent crimes such as disappearances often go unreported and unpunished, and the State of Mexico is widely considered ground zero for killings of women in the country today. The nonprofit Citizen Observatory Against Gender Violence, Disappearance and Femicides in Mexico State counted 263 femicides in 2016 alone.

Before Mexico State, it was Ciudad Juarez, across the border from El Paso, Texas, that was notorious for killings of women, with nearly 400 slain there since 1993 and only a handful of cases resulting in convictions. Common to both places are marginalized, peripheral communities with high levels of violent crime, corruption and impunity.

President Enrique Pena Nieto, who was Mexico State’s governor before assuming the presidency in 2012, said during his state of the union address this year that the country’s rising murders have more to do with common crime than organized crime.

But that has been no comfort for families who grieve for lost mothers, sisters and daughters, and who too often face daunting hurdles when seeking justice.

Jessica Sevilla lived in Villa Cuauhtemoc, a small town surrounded by corn fields and empty lots outside the state capital, Toluca, with her parents, her four younger sisters and her 1-year-old son, Leon. The daughter of a truck driver and a shop owner, she went to college and became a doctor, cementing her place as the pride of the family. Her mother said whenever Jessica wasn’t working or working out, she spent her time with Leon.

Jessica’s disappearance, on a Friday in August, set off a frantic 48 hours of searching by the family. Under the gender violence alert issued two years earlier, authorities are supposed to investigate any woman’s disappearance urgently. But Pedraza said authorities told her to wait until Sunday afternoon.

“And if she didn’t come back (by then), I would have to come on Monday so they could start searching for my daughter,” Pedraza said. “It was negligent, because otherwise we might be talking about my daughter being alive.”

Ana Yeli Perez, an attorney with the National Citizens’ Observatory Against Femicide, said that sort of response is all too common.

“Despite there already being tools that force public prosecutors to issue the gender violence alert, they refuse to launch investigations under the gender violence guidelines,” Perez said.

Femicides have been getting increasing attention elsewhere in Latin America as well. In Argentina, a coalition of activists, artists and journalists started a movement known as Ni Una Menos, or Not One Less, after a spate of killings. The name came from a poem about the killings in Ciudad Juarez by Mexican writer Susana Chavez, who herself was slain in 2011.

“Ni Una Menos” has become a widely used hashtag on social media in many places as more women turn up dead — as in the case of 19-year-old Mara Castilla, who disappeared after using a ride-hailing service in the central Mexican state of Puebla. The driver was arrested after it was determined that he never dropped her off at her house. Thousands of people gathered in Mexico City to protest her murder.

In Nezahualcoyotl, a group called Nos Queremos Vivas, or We Want to Stay Alive, sprung up after Valeria Gutierrez’s murder. It has organized marches and a self-defense workshop at a high school where 70 percent of the students are girls.

At one class, students threw punches and kicks on an indoor soccer court — and talked about learning to be afraid from a young age.

“I don’t feel safe. ... A woman cannot walk down the street freely because there are always people, men, who start harassing you, who try to touch you just because you’re wearing shorts or tight jeans,” said Monica Giselle Rodriguez, 15.

“We want to help them prepare in case they have to defend themselves,” martial arts instructor Cristofer Fuentes said.

Jessica Sevilla’s mutilated body was found on a highway about 20 miles (30 kilometers) from where she was last seen alive at a gas station in her red, brand-new Mazda. A week after the burial, Pedraza marched across town with family members carrying a stone cross to mark her grave. The murder remains unsolved.

Pedraza raised her five daughters to be confident that they are equal to men and that nobody can hold them back. Now tasked with raising her grandson, Leon, she said she’s focusing on the other side of the equation: Schools teach kids to read and write, but other values are instilled at home.

“With little Leon, we have the idea that we are going to teach him how to be a man,” Pedraza said. “You don’t hit women. You don’t insult them. If she can clear your plate, you can do it too. ... Equality and respect, above all.”